Navigating Congenital Nasal Obstruction: A Contemporary Surgical Paradigm

Area of Science:

• Otolaryngology
• Pediatric Surgery
• Medical Imaging

Background:

• Congenital nasal pyriform aperture stenosis (CNPAS) is a rare cause of neonatal airway obstruction.
• Persistent upper airway obstruction symptoms in newborns necessitate prompt diagnosis and management.
• CT paranasal sinuses and flexible endoscopy are key diagnostic tools.

Observation:

• Two newborns presented with persistent upper airway obstruction.
• Diagnosis of CNPAS confirmed by CT paranasal sinuses showing narrow nasal pyriform aperture (mean width 0.65 cm).
• Laryngomalacia was also identified in both infants via flexible endoscopy.

Findings:

• Surgical nasal dilation and stenting, combined with supraglottoplasty, resolved respiratory symptoms.
• This approach avoided the need for sublabial drill out of the pyriform aperture.
• Successful nasal enlargement was achieved with no post-operative complications.

Implications:

• Nasal dilation and stenting present a viable, less invasive alternative to traditional surgical bone removal for CNPAS.
• This technique potentially reduces surgical risks and offers an effective management option for selective CNPAS cases.
• Further studies on this minimally invasive approach for CNPAS are warranted.